The Importance of Biopsy in New Lower Extremity Lesions: A Case of Kaposi Sarcoma

Authors

• Michael A. Higham, The University of Texas Rio Grande Valley School of Podiatric MedicineFollow
• Stephanie N. Campbell, The University of Texas Rio Grande Valley School of Podiatric MedicineFollow
• Naomie Jean, The University of Texas Rio Grande Valley School of Podiatric MedicineFollow
• Amanda L. Killeen, The University of Texas Rio Grande Valley School of Podiatric MedicineFollow

Document Type

Poster

Publication Date

9-26-2026

Abstract

Introduction: Kaposi sarcoma is a vascular neoplasm associated with human herpesvirus-8 (HHV-8) that may present with atypical cutaneous findings in the lower extremity. Delayed diagnosis may occur when lesions resemble benign wounds or hypergranulation tissue, particularly in patients without a known oncologic history.

Aim: To present an atypical pedal presentation of Kaposi sarcoma initially encountered as a new lateral foot wound in an elderly patient with peripheral arterial disease and neuropathy.

Methods: An 80-year-old Hispanic male presented with a new “wound” of unknown duration on the lateral aspect of the left foot. Physical examination demonstrated xerotic skin with mild erythema and a pedunculated mass measuring 1.2 × 1.3 cm with a hypergranular base, macerated rim, and pain with palpation. The patient reported significant bleeding after manipulating the area after showering. No drainage was appreciated. Vascular examination revealed nonpalpable pulses with biphasic dorsalis pedis and monophasic posterior tibial and peroneal signals on Doppler. Protective sensation was diminished with Semmes-Weinstein monofilament testing. A shave biopsy of the lesion was performed.

Results: Histopathologic evaluation demonstrated Kaposi sarcoma with positive HHV-8, CD31, CD34, and ERG immunostaining. Following communication of the diagnosis and referral to medical oncology, the patient disclosed a prior history of cancer for which he did not pursue follow-up care due to limited understanding of the diagnosis and management recommendations. Subsequent records review identified a prior diagnosis of Kaposi sarcoma with previous oncology evaluation.

Conclusions: This case highlights the importance of maintaining suspicion for malignancy in unusual lower extremity wounds, particularly when lesions demonstrate excessive bleeding, exophytic growth, or extension beyond skin margins. Thorough history review, biopsy, and coordinated multidisciplinary follow-up are critical to avoid delays in diagnosis and treatment. Kaposi sarcoma remains clinically relevant despite declining prevalence, while border-region health literacy barriers may complicate diagnosis, education, and treatment.

Recommended Citation

Higham, Michael A.; Campbell, Stephanie N.; Jean, Naomie; and Killeen, Amanda L., "The Importance of Biopsy in New Lower Extremity Lesions: A Case of Kaposi Sarcoma" (2026). School of Podiatric Medicine Publications. 143.
https://scholarworks.utrgv.edu/sopm_pub/143

Academic Level

faculty